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Title: Patients' adherence to artemisinin-based combination therapy and healthcare workers' perception and practice in Savannakhet province, Lao PDR
Authors: Emiri Takahashi
Daisuke Nonaka
Moritoshi Iwagami
Vilay Phoutnalong
Ketmany Chanthakoumane
Jun Kobayashi
Tiengkham Pongvongsa
Sengchanh Kounnavong
Bouasy Hongvanthong
Paul T. Brey
Shigeyuki Kano
Institut Pasteur du Laos
University of the Ryukyus
National Center for Global Health and Medicine
Mahidol University
SATREPS Project for Parasitic Diseases
Savannakhet Provincial Health Department
Ministry of Health
Keywords: Medicine
Issue Date: 22-Dec-2018
Citation: Tropical Medicine and Health. Vol.46, No.1 (2018)
Abstract: © 2018 The Author(s). Background: Artemisinin resistance in Plasmodium falciparum has been spreading across Southeast Asia. Patients' adherence to artemisinin-based combination therapy (ACT) is critical to avoid expanding this resistance. The objectives of this research were to examine patients' adherence to ACT for the treatment of uncomplicated malaria and to examine the healthcare workers' perception of medication adherence and their dispensing practices for malaria patients in Savannakhet province, Lao PDR. Methods: A prospective observational study of patients and a descriptive study of healthcare workers were conducted in Xepon, Phin, and Nong districts. In the patient study, patients aged 18 years old or older who were prescribed artemether-lumefantrine (AL) at six healthcare facilities between October 2016 and August 2017 were examined. Patient interviews and tablet counts were conducted on the first day of treatment (day 0) and the follow-up day (around day 3). In the healthcare workers study, a self-administered questionnaire survey was conducted. Results: Of the 54 patients examined, 51 (94.4%) were adherent to the AL regimen. The other three patients stopped medication because they felt better, even though the importance of completing the regimen was explained to all patients when it was prescribed. Among 152 healthcare workers who had ever instructed a malaria patient, 74.3% reported that they occasionally saw a malaria patient who adhered poorly to medication instructions. The healthcare workers perceived the major reasons for poor adherence to be illiteracy and poor understanding of medication instructions by patients. In practice, 27.6% of the healthcare workers did not regularly explain the importance of completing the regimen to patients, and 32.2% did not often or always confirm the patients' understanding of medication instructions. Conclusions: Patient adherence to AL was high. The healthcare workers perceived that poor adherence was attributable to the patients, i.e., their poor understanding and illiteracy, which appeared to be related to linguistic differences. However, poor adherence also appeared to be attributable to the healthcare workers, who should tell patients of the importance of completing the AL regimen regardless of their improvement in physical condition and also confirm the patients' understanding of the instructions.
ISSN: 13494147
Appears in Collections:Scopus 2018

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